MRC Clinical Trials Unit, London, UK.
Curr Opin Infect Dis. 2011 Feb;24(1):27-33. doi: 10.1097/QCO.0b013e3283423e0e.
Patients on antiretroviral therapy (ART) in high-income countries have routine laboratory tests to monitor ART efficacy/toxicity. We review studies describing the outcomes and costs of different monitoring approaches, predominantly in low-income countries.
CD4 cell counts, HIV RNA viral load and clinical events are frequently discordant; viral load suppression occurs with WHO-defined CD4 failure and, as expected, viral load failure often occurs before CD4 failure. Routine CD4 monitoring provides small but significant mortality/morbidity benefits over clinical monitoring, but, at current prices, is not yet cost-effective in many sub-Saharan African countries. Viral load monitoring is less cost-effective with modelling studies reporting variable results. More research into point-of-care tests, methods for targeting monitoring and thresholds for defining failure is needed. Most laboratory monitoring for toxicity is neither effective nor cost-effective. In terms of models for delivery of care, task-shifting with nurse-led and decentralized care appear as effective as doctor-led or centralized care.
Recent studies have improved the evidence base for monitoring on ART. Future research to increase cost-effectiveness by better targeting of monitoring and/or evaluating implementation of less costly point-of-care tests will contribute to long-term success of ART while continuing to increase ART coverage.
在高收入国家，接受抗逆转录病毒疗法（ART）的患者会进行常规实验室检查，以监测 ART 的疗效/毒性。我们综述了描述不同监测方法的结局和成本的研究，这些研究主要在低收入国家进行。
CD4 细胞计数、HIV RNA 病毒载量和临床事件经常不一致；病毒载量抑制发生在世界卫生组织定义的 CD4 失败时，而且，正如预期的那样，病毒载量失败通常发生在 CD4 失败之前。常规 CD4 监测可带来较小但显著的死亡率/发病率获益，优于临床监测，但在许多撒哈拉以南非洲国家，目前其价格尚无法实现成本效益。病毒载量监测的成本效益较低，模型研究报告的结果存在差异。需要进一步研究即时检测、监测目标定位和失败定义阈值的方法。大多数针对毒性的实验室监测既没有效果，也没有成本效益。在提供护理的模式方面，护士主导和分散式护理的任务转移与医生主导或集中式护理一样有效。
最近的研究为 ART 监测提供了更好的证据基础。未来的研究将通过更好地针对监测目标以及评估成本较低的即时检测的实施情况来提高成本效益，这将有助于 ART 的长期成功，并继续提高 ART 的覆盖率。
